Risk assessment procedures are used by human services professionals to identify children who may be at risk of harm as a result of maltreatment. Most often, such assessments are conducted by child protection agencies charged with investigating allegations of child abuse. In such instances, risk assessment generally involves determining the likelihood of future maltreatment and deciding whether action is needed to reduce the risk of future harm. The definition of child maltreatment can vary with regard to scope, frequency, and severity, but it generally entails an act of commission or omission that is damaging or harmful, or can result in damage or harm, to the child’s physical or psychological well-being. Child maltreatment is categorized into specific acts of physical abuse, sexual abuse, neglect, and emotional abuse including witnessing domestic violence.
Historically, social services workers have relied upon clinical skills derived from a mixture of professional judgment and intuition to make attributions of risk. However, clinical judgment may be an inadequate predictor of future risk and can result in poor decisions that have serious implications for children and families (i.e., children are mistakenly left in homes that are abusive or children are mistakenly separated from their caregivers). Commonly found circumstances contributing to uncertainty in cases of alleged child maltreatment can include differences in parenting styles, cultural variations in parenting, environmental characteristics, the values and policies of agencies and the broader community toward child maltreatment, worker training related to decision making, and the organizational context of child welfare agencies.
Standardized risk assessment measures have been developed in child welfare in an effort to address these shortcomings and to target scarce resources, and these have been adopted widely across the United States, Canada, and Australia. Standardized risk assessment instruments have been used for many years in other practice fields, including medicine, health, and criminology. In general, their improved reliability, validity, and objectivity enhance decision making. Standardized risk assessment tools differ regarding their scope, construction, and reliance on various factors to predict risk, but they share a common goal: to help social service workers more accurately determine the likelihood of child maltreatment based on the presence of certain family characteristics and environmental conditions considered to be highly associated with maltreatment.
Standardized tools generally involve three separate functions: (1) screening for potential maltreatment in the general population, (2) assessing the risk of recurrence of maltreatment in populations being investigated by child protection services, and (3) assessing the risk of maltreatment among children who have been returned to their parents after residing in foster care. Although these categories overlap to some extent, the factors that predict initial occurrence are not necessarily the same factors that predict maltreatment recurrence. Instruments developed within these three areas differ in terms of their underlying construction (e.g., consensus-based vs. actuarial), sources of information (e.g., caregiver, child, caseworker), number of risk factors included, and scoring of risk factors (e.g., range of choices for each category). Although most of the items appear to have been derived or at least supported by empirical studies, many factors have not been validated for use in risk assessment instruments.
Risk Factors For Child Maltreatment
Programs targeting high-risk families have had some degree of success at decreasing the incidence of child maltreatment, and risk assessment can be used to more accurately identify high-risk children and families. Factors that have been identified as related to initial maltreatment include maternal and paternal depression, substance abuse, unemployment, social isolation, unrealistic expectations of the child, parental history of being abused, and increased caregiver stress. Factors specific to initial physical maltreatment include young maternal age, single parent status, parental history of physical abuse, spousal violence, unplanned or negative attitudes toward pregnancy, history of parental substance abuse, parent social isolation, maternal psychiatric impairment, low maternal education, low socioeconomic status, and large family size. Factors related to the initial risk of sexual maltreatment include living in a family without a natural parent; living in one in which there is a poor relationship between parents, there is the presence of a stepfather, or there are poor child–parent relationships; or living in a family when there was a low maternal age or there was a parental death.
Assessing risk of recurrence for cases where there has been an allegation of child maltreatment fall into two broad categories: safety assessment and risk assessment. Safety assessment generally involves answering a series of questions related to the immediate threat of harm, while risk assessment generally refers to the longer-term likelihood that a child will be reabused if he or she remains with the caregiver(s) (usually a birth parent). Many factors have been associated with recurrence of maltreatment including prior incidents of maltreatment, unrealistic expectations of the child by the parent, contact between the child and the perpetrator, the number of children in the home, poor parenting skills, the child’s fear of a parent, the child’s continued contact with the perpetrator, and the presence of multiple subtypes (i.e., physical abuse, neglect, and/or sexual abuse) of maltreatment. In a rigorous systematic review examining 15 studies from the United States and one study from Australia, Hindley, Ramchandani, and Jones found that the four most consistent factors predicting future maltreatment included the number of previous episodes of maltreatment, neglect (as opposed to other forms of maltreatment), parental conflict, and parental mental health problems.
Risk factors found to be related to the risk of maltreatment among children who have been returned to their parents after residing in foster care include young age at return to parents, child health problems, placement in foster care with nonrelatives, increased placement moves while in foster care, and shorter stays in foster care.
Instruments
General Screening
One of the more commonly used tools to screen the general population of maltreatment risk is the Child Abuse Potential Inventory (CAPI). Developed by Milner, the CAPI is a 160-item self-report questionnaire designed to describe parenting attitudes and beliefs, parental psychological functioning, and parents’ perception of their relationship with their child, family, and community. However, screening approaches for initial risk of child maltreatment, including the CAPI, have been found to have unacceptably high false-positive rates. That is, many parents are incorrectly identified as having high maltreatment potential.
Assessing The Risk Of Recurrence Of Maltreatment
In terms of risk of maltreatment recurrence, some of the more commonly used instruments include the Washington Risk Assessment Matrix (WRAM), the California Family Assessment Factor Analysis (CFAFA or the Fresno model), the Alaska model, the Child at Risk Field, the Child Emergency Response Assessment Protocol, the Child Well-Being Scales or the Family Risk Scales, Risk Assessment Model, and the actuarial risk assessment instruments developed by the Children’s Research Center (CRC).
Although the evidence of individual risk assessment models is mounting, most tools do not meet established standards for reliability and predictive validity. Nonetheless, a wide range of studies from many fields have found that actuarial (statistically driven) prediction is at least as good, and most often better, than unassisted clinical prediction. Investigations of the CANTS 17B, a child abuse and neglect tracking system, and WRAM, the Washington Risk Assessment Matrix, have found them to be to be inadequate predictors of maltreatment recurrence. In one of the few studies to compare the relative validity of different systems, Baird and Wagner compared the WRAM and a derivation of the CANTS 17B (the CFAFA), both consensus-based instruments, with Michigan’s actuarial Family Risk Assessment of Abuse and Neglect (FRAAN). Not surprisingly, FRAAN’s actuarial approach substantially outperformed the other tools in terms of correctly classifying high-risk families who later maltreated their children. Extending these findings, prospective validation of CRC’s California Family Risk Assessment found that the instrument was able to correctly classify potentially maltreating families into low, moderate, high, and very high risk categories at levels beyond chance.
Reentry TO Foster Care
Less rigorous research has been focused on developing and evaluating instruments measuring the risk of reentry into foster care. This lack is likely due to the relatively low rate of recidivism, making it difficult to generate sample sizes large enough to create a reliable, valid risk assessment tool.
Conclusion
Predicting human behavior is inherently difficult; therefore, classifications of risk are generally used to inform rather than to determine service decisions. Risk assessment instruments are simply tools used to predict. Assessment tools are not designed to assess such things as family dynamics or other important functional issues, nor do they constitute treatment plans. Placing risk assessment findings in context and arriving at ways to prevent and/or minimize the consequences of future behavior requires clinical and professional expertise.
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